Guardians LERC Membership Application | Lee, Charlotte & Collier Counties

Personal Information

Please provide your current contact information. Fields marked with an * are required.

First Name *

Middle Name

Last Name *

Email Address *

Phone Number *

Date of Birth *

Street Address *

City *

State *

ZIP Code *

County *

Law Enforcement & Public Service Background

Please tell us about your law enforcement, public safety, military, or related background.

Current Affiliation *

Agency / Department / Organization

Rank / Position

Years of Service

Primary Area of Service

Tell Us About Your Law Enforcement, Military or Public Service Background

Motorcycle & Riding Information

Tell us about your motorcycle and riding experience.

Do You Currently Own or Regularly Ride a Motorcycle? *
YesNo

Motorcycle Make

Motorcycle Model

Model Year

Do You Hold a Valid Motorcycle Endorsement / License? *
YesNo

Is Your Motorcycle Currently Insured? *
YesNoNot Applicable

Approximately How Many Years Have You Been Riding?

Group Riding Experience *

Are You Currently a Member of Another Motorcycle Club, Riding Club or Association?
YesNo

If Yes, Please Provide the Club / Organization Name

Applicant Declaration

Please review the following statements before submitting your application.

By submitting this application, I understand that applying to Guardians LERC does not automatically guarantee membership.

I understand that membership may be subject to review and approval in accordance with Guardians LERC membership requirements, bylaws, policies and chapter procedures.

I certify that the information provided in this application is true and accurate to the best of my knowledge.

I understand that, if accepted, I am expected to conduct myself in a manner consistent with the values, standards and reputation of Guardians LERC.

I authorize Guardians LERC to contact me regarding this application, membership, meetings, rides and related club activities.

I understand that submission of this application does not constitute acceptance or membership in Guardians LERC.

Electronic Signature

Applicant Full Name *

Date *